Relaxing Retinotomy Research Articles

Outcomes after giant peripheral retinotomy and anterior flap retinectomy for rhegmatogenous retinal detachments with advanced proliferative vitreoretinopathy using small gauge vitrectomy.

To analyze the visual and anatomical outcomes for eyes with rhegmatogenous retinal detachment (RRD) and advanced proliferative vitreoretinopathy (PVR) undergoing giant peripheral retinotomy (GPR) using 25-gauge pars plana vitrectomy (PPV). In this retrospective multi-center study, patients with RRD with either anteroposterior or circumferential retinal shortening and advanced PVR requiring more than 90-degree GPR with/without relaxing retinotomy were included. Subjects of either gender, any age group, and with complete surgical notes were included. Outcome measures of the study included anatomical success (i.e. complete retinal re-attachment) at 6 months using survival analysis, visual outcomes, and post-operative complications. Forty-one eyes of 41 patients (33 males) with a mean age of 44.9 ± 21.4 years were included. At 6 months follow-up, anatomical success was seen in 29 eyes (70.7%) with a cumulative re-attachment rate of 66% (95% confidence interval = 48 = 79%). All re-detachments occurred at ≤6 months with a peak at 4-6 months (n = 9). Twenty-three eyes (56%) achieved ambulatory vision (5/200) or better. Direct perfluorocarbon liquid-silicone oil exchange was performed in 20 eyes. Intra-operative complications included persistent retinal folds (2 eyes), subretinal air (1 eye), and subretinal bleed (1 eye). Eleven eyes (26.8%) developed secondary glaucoma (2 eyes required a drainage device), and hypotony of ≤6 mmHg was noted in 3 eyes (7.3%). Corneal decompensation was noted in 8 eyes (19.5%), and 3 eyes (7.3%) underwent re-surgery for re-RRD. After GPR using small gauge PPV, two-thirds achieve anatomical success, and over half have ambulatory vision, but overall post-operative complications can occur in more than half of the eyes.

Relaxing Retinotomy in Recurrent and Refractory Full-Thickness Macular Holes: The State of the Art.

The prevailing standard of care for primary repair of full-thickness macular holes (FTMHs) is pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, as it gives a high closure rate of roughly 90%. On the other hand, the surgical management of recurrent and refractory FTMHs represents, so far, a demanding and debated subject in vitreoretinal surgery since various approaches have been proposed, with no consensus concerning both adequate selection criteria and the best surgical approach. In addition, the existence of multiple case series/interventional studies showing comparable results and the lack of studies with a direct comparison of multiple surgical techniques may lead to uncertainty. We present an organized overview of relaxing retinotomy technique, a surgical approach available nowadays for the secondary repair of recurrent and refractory FTMHs. Besides the history and the description of the various techniques to perform relaxing retinotomies, we underline the results and the evidence available to promote the use of this surgical approach.

Prospective Comparison of Surgery Outcome Between Preoperative and Intraoperative Intravitreal Injection of Ranibizumab for Vitrectomy in Proliferative Diabetic Retinopathy Patients.

IntroductionTo compare the efficacy and safety of intravitreal injections of ranibizumab (IVR) before and at the end of vitrectomy in proliferative diabetic retinopathy (PDR) patients.MethodsA prospective comparative study was performed on 60 eyes of 52 PDR patients who received ranibizumab injection (0.5 mg/0.05 ml) 3–5 days before vitrectomy (preoperative group) and 55 eyes of 50 PDR patients who received ranibizumab injection (0.5 mg/0.05 ml) at the end of vitrectomy (intraoperative group). Intra- and postoperative indices were collected for further comparison.ResultsPostoperative best-corrected visual acuity (BCVA) in preoperative group was better than in intraoperative group at 1 week after surgery (P < 0.05) but comparable at 1- and 3-month follow-up (P = 0.20 and P = 0.37, respectively). Central retinal thickness (CRT) in preoperative group was lower than in intraoperative group at 1 week postoperatively (P < 0.05), but comparable at 1- and 3-month follow-up (P = 0.39 and P = 0.77, respectively). The average surgery time was significantly shorter in preoperative group than in intraoperative group (61.50 ± 11.44 min vs. 74.49 ± 12.01 min, P < 0.01). The incidence of intraoperative bleeding was significant lower in preoperative group than in intraoperative group (21.7% vs. 40.0%, P < 0.05). Moreover, the incidence of intraocular electrocoagulation use, iatrogenic retinal breaks, relaxing retinotomy and silicone oil tamponade were all significantly lower in preoperative group than that in intraoperative group (P < 0.05, respectively). The incidences of postoperative vitreous hemorrhage (VH), neovascular glaucoma (NVG), recurrent retinal detachment, postoperative fibrovascular proliferation progression and reoperation showed no statistical differences between the two groups (P > 0.05, respectively). Both groups had no ocular or system adverse events during observation period.ConclusionIn vitrectomy for PDR, preoperative IVR can significantly reduce surgery time and lower the incidence of intraoperative bleeding, intraocular electrocoagulation use, iatrogenic retinal breaks, relaxing retinotomy and silicone oil tamponade during surgery and gain short-term better postoperative BCVA and thinner CRT.Trial registration: ClinicalTrials.gov (identifier, NCT05408416).

Management of inadvertent scleral penetration during retinal detachment surgery

We report the management of a case of inadvertent full-thickness scleral penetration during rhegmatogenous retinal detachment (RRD) surgery in a 14-year-old high myope while making partial-thickness scleral tunnel for the passage of the 240 silicone band. Sudden and gross hypotony with subretinal hemorrhage were noted post-penetration. Hypotony was immediately addressed by suturing the penetration site with a 7-0 vicryl suture. Subretinal blood was removed by performing 360° relaxing retinotomy and retinectomy and the retina was attached. This case report highlights the possible reasons for the full-thickness scleral penetration and one of the various methods to handle the same.

Refractory full thickness macular hole: current surgical management.

This review aims to collect the proposed surgical techniques for treating full thickness macular hole (FTMH) refractory to pars plana vitrectomy and internal limiting membrane (ILM) peeling and to analyse and compare anatomical and functional outcomes in order to evaluate their efficacy. The articles were grouped according to the surgical techniques used. Refractory FTMH closure rate and best-corrected visual acuity (BCVA) gain were the two analysed parameters. Thirty-six articles were selected. Ten surgical technique subgroups were defined: autologous platelet concentrate (APC); lens capsular flap transplantation (LCFT); autologous free ILM flap transplantation (free ILM flap); enlargement of ILM peeling, macular hole hydrodissection (MHH), autologous retinal graft (ARG), silicon oil (SO), human amniotic membrane (hAM), perifoveal relaxing retinotomy, arcuate temporal retinotomy. Refractory FTMH closure rate was similar among subgroups, not significant heterogeneity emerged (p = 0.176). BCVA gain showed a significant dependence on surgical technique (p < 0.0001), significant heterogeneity among subgroups emerged (p < 0.0001). Three sets of surgical technique subgroups with a homogeneous BCVA gain were defined: high BCVA gain (hAM); intermediate BCVA gain (APC, ARG, LCFT, MHH, SO); low BCVA gain (free ILM flap, enlargement of peeling, arcuate temporal retinotomy). In terms of visual recovery, the most efficient technique for treating refractory FTMH is hAM, lens capsular flap and APC that allow to obtain better functional outcomes than free ILM flap. MHH, ARG, perifoveal relaxing and arcuate temporal retinotomy require complex and unjustified surgical manoeuvres in view of the surgical alternatives with overlapping anatomical and functional results.

Relaxing retinotomies and retinectomies in case of proliferative diabetic vitreoretinopathies and tractional retinal detachment

IntroductionRadical anterior vitreous base dissection and lensectomy in combination with inferior 180° retinectomy will improve the anatomic success of complex proliferative diabetic vitreoretinopathies (PVR)-related retinal detachment. Our study aims to describe the anatomical and functional results of pars plana vitrectomy with retinotomies and relaxing retinectomies in patients with tractional retinal detachment in advanced PVR.Patients and methodsA case series study was conducted on 28 eyes of patients with tractional retinal detachment with severe PVR. Preoperative and postoperative complications and final visual outcomes were recorded. The follow-up period was 12 months.ResultsFull reattachment rate was reached intraoperatively in 26 (92.9%) eyes, with final complete reattachment success rate in 22 (78.5%) eyes at least 6 months of follow-up. A total of 17 (60.7%) eyes had their best-corrected visual acuity (BCVA) improved at 6 months postoperatively, and reaching a final BCVA of more than or equal to 2/60 at 6 months. The BCVA remained stable in six (21.4%) eyes and declined in five (17.9%) eyes. The complications postoperatively included secondary glaucoma (three eyes), retinal redetachment (four eyes), and hypotony (two eyes).ConclusionPars plana vitrectomy with relaxing retinotomies and retinectomies is an effective treatment method for complex PVR-related retinal detachment. Improved preoperative visual acuity, lower PVR extension, and silicone oil tamponade use during the early recovery period are essential factors for good anatomical and visual outcomes and a lower rate of complications.

Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment

Purpose:To describe a bimanual technique, “tug of war” for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD).Methods:We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped.Results:Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3–8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04).Conclusion:The 'tug of war' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.

DOUBLE ARCUATE RELAXING RETINOTOMY FOR A LARGE MACULAR HOLE

To describe double arcuate relaxing retinotomy as an alternative surgical technique in a case with a secondary large macular hole. The management of a patient who developed a large macular hole and macular tractional rhegmatogenous retinal detachment after pars plana vitrectomy for proliferative diabetic retinopathy was retrospectively assessed. Despite surgical procedures, such as dissection of a preretinal membrane from the retina and peeling of the retinal internal limiting membrane, the macular hole could not be closed. In the absence of an alternative method, superior and inferior posterior arcuate, 120° relaxing retinotomies were performed. At the follow-up, the macular hole closure was confirmed by clinical examination and optical coherence tomography imaging, and visual acuity improved. There were no intraoperative or postoperative complications. In cases of large macular holes, double arcuate relaxing retinotomy can reduce traction, leading to hole closure.

Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials

Background/aimsTo evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR).MethodsThe PubMed, Embase and the Cochrane Central Register of...

INTRAVITREAL CONBERCEPT (KH902) FOR SURGICAL TREATMENT OF SEVERE PROLIFERATIVE DIABETIC RETINOPATHY.

To evaluate the role, safety, and effectiveness of intravitreal conbercept (KH902) injections as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy. A randomized controlled trial was performed on 36 eyes of 36 patients affected by vitreous hemorrhage and tractional retinal detachment, which occurred as a consequence of active proliferative diabetic retinopathy. The patients were randomly assigned to two groups. The patients in one of the groups received an intravitreal injection of conbercept in the inferior temporal sector 4 mm from the sclerocorneal limbus with a sterile technique 1 week before vitrectomy. In the group without conbercept, intraoperative bleeding occurred in 14 patients (77.8%), and in five of these cases, bleeding was significant. The use of endodiathermy was necessary in 8 patients (44.4%). In 3 patients (16.6%), iatrogenic retinal breaks occurred, and in 1 patient (5.5%), a relaxing retinotomy was performed. Endotamponade with silicone oil was performed in 12 patients (66.6%). In the group treated with conbercept, intraoperative bleeding occurred in 2 cases (11.1%). The use of endodiathermy was necessary in 1 patient (5.5%). No patients experienced iatrogenic breaks or relaxing retinotomy during the surgery. Endotamponade with silicone oil was performed in 2 patients (11.1%). Preoperative intravitreal injection of conbercept could reduce the chances of intraoperative bleeding, which are beneficial in the management of proliferative diabetic retinopathy.

Dashed line relaxing retinotomy in the management of retinal detachment with anterior proliferative vitreoretinopathy.

BackgroundWe describe the anatomical and functional outcomes of eyes that underwent a modified technique of relaxing retinotomy, dashed line relaxing retinotomy, in the management of retinal detachment with anterior proliferative vitreoretinopathy.MethodsWe retrospectively reviewed 54 consecutive eyes in 52 patients who received pars plana vitrectomy with relaxing retinotomy during retinal detachment repair. Perfluorocarbon liquid (PFCL) was used as a standard procedure to stabilize the retina during retinotomy to prevent slippage or inversion of the posterior flap. If PFCL was not available due to economic reasons, dashed line relaxing retinotomy was performed instead. Best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement, lens status, and fundus examination were analyzed. We excluded patients who were followed up <4 months.ResultsRegarding anatomical success rates and visual outcomes, we found no significant differences between patients treated with intraoperative PFCL and those treated with dashed line relaxing retinotomy without PFCL.ConclusionCompared to the simple and efficient PFCL-assisted relaxing retinotomy, dashed relaxing retinotomy is not the first choice when PFCL is available. Based on our results, this modified technique may offer an alternative in patients with anterior proliferative vitreoretinopathy for whom PFCL is not available.

Deferred laser photocoagulation of relaxing retinotomies under silicone oil tamponade to reduce recurrent macular detachment in severe proliferative vitreoretinopathy

This study sought to investigate whether, in patients with retinal detachment complicated by proliferative vitreoretinopathy, we can re-attach the retina with a posterior relaxing retinotomy and silicone oil tamponade while postponing laser retinopexy for several months. In 13 consecutive patients we applied laser coagulation of the retinotomy edge 15 ± 12 weeks after surgery. Silicone oil was removed 9 ± 6 weeks after laser application. After the retinotomy without laser, some degree of central shifting was seen in all patients, followed by obvious curling in 10 patients. The total follow-up was 24 ± 7 months after retinotomy and 13 ± 9 months after oil removal. The retina was attached in 12 patients at the last visit, with the oil still in situ in three patients. Seven patients, however, required additional surgery. Function remained stable with a mean preoperative and postoperative Snellen visual acuity of 0.09. Not anchoring retinotomy edges with a laser at the time of surgery allows inward curling and central slippage of retinal edges under silicone oil. This appears to compensate for the retinal fibrosis occurring in the weeks following surgery and may result in less macula-off re-detachments under oil, and potentially, in better visual outcome.

Visual and anatomical outcomes after silicone oil removal in patients with complex retinal detachment

To evaluate outcomes of temporary silicone oil (SO) tamponade in patients with complex retinal detachment. A retrospective study of 184 eyes of 177 consecutive patients who underwent SO removal (SOR) by one surgeon between 2000 and 2010. Indications for the use of SO were proliferative vitreoretinopathy (56 eyes), difficult rhegmatogenous retinal detachment (RRD) (58 eyes), diabetic traction retinal detachment (DTRD) (29 eyes), RRD due to macular hole in highly myopic eyes (16 eyes), giant retinal tears (13 eyes), and RRD after penetrating trauma (12 eyes). All eyes underwent prophylactic 360° laser retinopexy and encircling buckle at the time of primary surgery. The mean duration of SO tamponade was 47 weeks, with a mean follow-up of 66.9 weeks after SOR. Anatomical success after SOR was achieved in 96.73 %. Final visual outcome of ≥20/200 was significantly higher in eyes with RRD compared to eyes with DTRD. Young age (≤16 years), performance of pars plana lensectomy at primary procedure and presence of pseudophakia at last follow-up were factors associated with good visual outcome in eyes with RRD. Factors predicting attached retina at last follow-up were older age (>16 years), normal intraocular pressure (IOP) at initial presentation and no relaxing retinotomy performed during the primary procedure in eyes with RRD. Complications were cataract (100 %) in phakic eyes, increased IOP (15.7 %), keratopathy (3.8 %), and hypotony (2.1 %). The low redetachment rate after SOR in the present study might be due to prophylactic 360° retinopexy and use of encircling buckles at time of primary retinal reattachment.

Retinal detachment with PVR

AbstractThe goal of surgery for PVR is to reattach the retina by identifying all retinal breaks and relieving all significant vitreoretinal traction. Vitrectomy ,membrane peeling and gas or silicone oil tamponade are required in most cases. Firstly, a meticulous pars plana vitrectomy and shaving of the vitreous base is performed. This is followed by a 360‐degree, scleral‐depressed peripheral retinal examination using a wide‐field viewing system to identify and then diathermize all the retinal breaks. The important goal of PVR surgery is complete membrane peeling to relieve all tangential retinal traction, thus allowing the retina to conform to the RPE/choroid. ILM peeling at the macula is also part of the treatment to prevent pucker formation or redetachment of the macula. In cases where there is persistent traction despite complete membrane peeling a sufficiently large relaxing retinotomy must be performed to relieve the persistant retinal traction. The retina is then temporarily flattened under air ,or perfluorocabon. Next, all of the retinal breaks and edges of any retinotomies are treated confluently with laser. The intraocular gas or silicone oil are typically used to provide extended long term endoretinal tamponade.

Transscleral Drainage of Subretinal/Suprachoroidal Silicone Oil

Silicone oil migration into the subretinal space following vitreoretinal surgery may occur in complex cases of retinal detachment with proliferative vitreoretinopathy. This complication prevents achievement of the primary goal (ie, to attach the retina) and fails to provide the internal tamponade, leading to a permanent decrease in visual acuity. Successful and complete removal of the subretinal oil is a challenge. Internal drainage as described earlier in the literature advocates a large relaxing retinotomy. The authors describe two similar cases, one with retinal detachment secondary to type II iridochoroidal coloboma wherein the oil had passed into the subretinal space and the other with diabetes mellitus and retinal detachment with oil in the suprachoroidal space. In both cases, silicone oil was removed successfully through a transscleral approach. The transscleral approach for removal of subretinal/suprachoroidal oil appears to be relatively safe, less time-consuming, and effective.

Comment to: the use of silicone oil-RMN3 (Oxane HD) as heavier-than-water internal tamponade in complicated inferior retinal detachment surgery

Dear Sir, We read with interest the recent article of Doctors Whickham et al. on their use of Oxane in the treatment of complex inferior retinal detachment, and would like to question a few points and make our own comments. When classifying the grade of retinal detachment in the study group, three recurrent detachments were said not to have grade C PVR, whilst in the overall grade of PVR in the same table two patients in the study group had non-grade C PVR (one with no PVR, and one grade B). The median duration of retinal detachment for the study group lies outside the inter-quartile range for that group and is probably at least double the duration of the control group in reality. As the presence of residual silicone oil is stated as a secondary outcome, we feel a more detailed account of the technique of removal should be presented. Heavy silicone oil is acknowledged to be stickier and hence more difficult to remove than standard oil. We have modified our original technique after early experiences with Oxane and now prefer to perform repeated fluid–air exchanges unless all visible oil droplets are removed from the vitreous cavity. The authors rightly state that in their small nonrandomised case series there is no statistical difference in primary outcome measures between the two groups. However, the two groups are not well-matched for comparison, as patients treated with conventional oil were asked to posture for 5 days postoperatively, while the HSO group did not posture. This difference in posturing instruction alone could have resulted in improved retinal reattachment rates with standard oil. An alternative conclusion that their results would support is that for patients who are unable or unwilling to posture after complex inferior retinal detachment surgery the use of Oxane should be considered. The authors have reported hypotony in four cases, one in the standard and three in the HSO group. It is not clear from the data how many patients underwent inferior relaxing retinotomies, as this may have contributed to hypotony by improving uveo-scleral outflow. Oil was said to be removed at 3 months (90 days) unless contraindicated. Where this data is presented (Table 5), the mean (and median) ROSO time is 5.3 months (160 days) which is significantly longer, and if earlier oil removal were possible it would be interesting to compare the complication profile. Our personal experience with HSO (Oxane HD) in the context of failed macular hole repair (unpublished data, manuscript in preparation) indicates that removal as early as 6 weeks after insertion significantly lowers the incidence of postoperative uveitis and glaucoma.

Intravitreal bevacizumab for surgical treatment of severe proliferative diabetic retinopathy

The purpose of this study is to evaluate the role, the safety and the effectiveness of intravitreal bevacizumab (IVB) injections as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy (PDR). Case-Control Study Randomized controlled trial performed on 72 eyes of 68 patients affected by vitreous haemorrhage (VH) and tractional retinal detachment (TRD), which occurred as a consequence of active proliferative diabetic retinopathy (PDR). We randomly assigned eligible patients in a 1: 1: 1 ratio to receive a sham injection or an intravitreal injection of 1.25 mg of bevacizumab, either 7 or 20 days before the vitrectomy. In order to obtain three homogeneous groups of surgical complexity, we assigned to the following preoperative parameters a score from 0 to 3: a) vitreous haemorrhage, b) prior retinal laser-photocoagulation, c) morphological types of retinal detachment such as focal, hammock, central diffuse, table-top. Complete ophthalmic examinations and color fundus photography were performed at baseline and 1, 6, 12, and 24 weeks after the surgery. Intraoperative management, safety, efficacy of IVB at different time injection as an adjunct to vitrectomy in the management of severe PDR RESULTS: Group A (sham injection): intraoperative bleeding occurred in 19 cases (79.1%), the use of endodiathermy was necessary in 13 patients (54.1%), relaxing retinotomy was performed on one patient (4.1%), and in four cases (16.6%) iatrogenic retinal breaks occurred. The surgical mean time was 84 minutes (SD 12 minutes). Group B (bevacizumab administered 7 days before vitrectomy): intraoperative bleeding occurred in two cases (8.3%) and the use of endodiathermy was necessary in two patients (8.3%). No iatrogenic breaks occurred during the surgery. The surgical mean time was 65 minutes (SD 18 minutes). Group C (bevacizumab administered 20 days before vitrectomy): intraoperative bleeding occurred in three cases (12.5%), the use of endodiathermy was necessary in three patients (1.5%), and an iatrogenic break occurred in one patient (4.1%) while the delamination of fibrovascular tissue was being performed. The surgical mean time was 69 minutes (SD 21 minutes). The average difference in the surgical time was statistically significant between group A and group B (p = 0.025), and between group A and group C (p = 0.031). At the end of the surgery, the retina was completely attached in all eyes. At the 6-month follow-up, we observed the development of tractional retinal detachment (TRD) in one out of 24 patients from group C (4%). A preoperative intravitreal injection of bevacizumab may represent a new strategy for the surgical treatment of severe PDR by reducing retinal and iris neovascularization: this would make surgery much easier and safer, thus improving the anatomical and functional prognosis. According to our study, the best surgical results are achieved performing the IVB 7 days preoperatively.

Relaxing retinotomies and retinectomies in the management of retinal detachment with severe proliferative vitreoretinopathy (PVR)

Relaxing retinotomies and retinectomies are used in the presence of retinal shortening resulting from retinal incarceration or fibrous proliferation and contraction that prevents contact of the retina with the retinal pigment epithelium. The peripheral retina is usually cut or excised to preserve function of the posterior retina which is more visually significant.ObjectiveTo investigate the techniques, therapeutic effects, indications, and complications of relaxing retinotomies and retinectomies for complicated retinal detachment with severe proliferative vitreoretinopathy (PVR).MethodsThirty eight eyes of 38 patients of complicated retinal detachment with severe PVR were recruited for a noncomparative retrospective study. They were operated on and followed-up for at least six months. The operative technique included buckling, vitrectomy, peeling, relaxing retinotomy and/or retinectomy, intraocular tamponade, and laser treatment.ResultsRetina was reattached in 34 (89.5%) eyes in operations. Retinal detachment was recurrent in seven eyes in follow-up, in which the retina was reattached again in two eyes by a second operation. The final success rate was 76.3% (29 eyes out of 38 eyes). Visual acuity was perception of light with bad projection in 35 (92%) eyes and hand motion in three (8%) eyes before operation. Visual acuity was better than 4/60 in 23 eyes (60.5%) after operation. The complications included iatrogenic retinal breaks, bleeding from the retinotomy site, hypotony, and recurrent fibrous proliferation from the retinotomy site.ConclusionRetinotomy and retinectomy can improve the curative effect of complicated retinal detachment. There are potentially serious complications of these maneuvers and they should not be performed if less aggressive measures will suffice.

Rhegmatogenous retinal detachment associated with myelinated nerve fibers: a case report.

To report the management of a case of rhegmatogenous retinal detachment associated with myelinated nerve fibers. A 7-year-old boy presented with decreased vision in the right eye for 3 months. Fundus examination revealed total retinal detachment with a large break within the myelinated nerve fibers in the right eye. The right eye underwent pars plana vitrectomy, encirclage, relaxing retinotomy, endolaser, and C3F8 injection. The retina remained attached at the 6-month follow-up with visual acuity of 6/18, N10. An area of the retina with myelinated nerve fiber is stiff and could potentially pose problems in retinal reattachment when a retinal break is located within the same area.

Influence of Postoperative Lens Status on Intraocular Pressure in Proliferative Vitreoretinopathy

To determine the influence of lens status on postoperative intraocular pressure (IOP) in eyes undergoing vitrectomy for repair of recurrent retinal detachment (RD) resulting from proliferative vitreoretinopathy (PVR). Retrospective, consecutive, nonrandomized, single-center series. One hundred and forty-five eyes with recurrent RD resulting from PVR were reviewed retrospectively. In all, 99 eyes underwent relaxing retinotomy at the time of surgery (68.4%). Perfluorocarbon gas (n = 60) or silicone oil (n = 85) were used as postoperative tamponades. For analysis, eyes were subdivided first based on tamponade and retinotomy status. The resultant groups then were divided further by lens status into 2 groups: aphakic eyes (aphakic group) and phakic and pseudophakic eyes (nonaphakic group). Surgical reattachment was achieved in all eyes except one. Eyes receiving both silicone oil and relaxing retinotomy had the worst baseline characteristics compared with those receiving other interventions. In this subset of eyes, a significantly lower proportion of hypotony was found in those eyes that were aphakic after surgery when compared with those eyes that were nonaphakic (P = .037). Surgical management of PVR often results in ultimate retinal reattachment. In eyes receiving both relaxing retinotomy and silicone oil, higher IOPs and a lower proportion of hypotony are found where a native lens or intraocular implant is absent. Removal of the lens or intraocular implant may be considered for those eyes at greatest risk of hypotony.